目的: 探讨慢性乙型肝炎病毒（Hepatitis B virus,HBV）感染者常规实验室检查指标与肝纤维化程度相关性。方法: 回顾性分析2023年1月—2023年12月期间广东医科大学附属茂名临床医学院感染科收治的202例慢性HBV感染患者的临床资料。根据肝脏硬度（liver stiffness measurement,LSM）值,患者被分为F0~F1期（n=84）、F2期（n=56）、F3期（n=48）和F4期（n=14）。检测患者血常规、凝血功能和肝功能指标,并分析这些指标与肝纤维化严重程度的相关性。绘制受试者工作特征（receiver operating characteristic,ROC）曲线,进一步评估血常规、凝血功能和肝功能指标单独及联合运用在预测肝纤维化严重程度中的价值,并确定各项指标的诊断阈值及曲线下面积（AUC）。结果: 随着肝纤维化分期的加重,血小板计数（platelet count,PLT）、凝血酶原活动度（prothrombin activity,PTA）、白蛋白（albumin,ALB）及胆碱酯酶（cholinesterase,CHE）水平逐渐下降,在F4期降至最低;而胆汁酸/血小板比值（bile acid to platelet ratio,TRP）、谷草转氨酶/血小板比值指数（alanine transaminase-to-platelet ratio index,APRI）,总胆红素（total bilirubin,TBIL）、直接胆红素（direct bilirubin,DBIL）及γ-谷氨酰转肽酶（gamma-glutamyl transferase,GGT）水平则随分期升高。Pearson相关性分析显示,TRP、APRI、TBIL、DBIL和球蛋白（globulin,GLB）与肝纤维化程度呈正相关,PLT呈负相关。ROC曲线分析结果表明,13项常规指标联合预测肝纤维化严重程度的AUC为0.930,敏感性为0.894,特异性为0.923,显著优于任一单项指标,提示联合评估具有较高预测价值。结论: 血常规、肝功能及凝血功能等实验室常规指标与慢性HBV感染者肝纤维化程度密切相关,其中PLT在晚期纤维化中下降最为显著。将TRP、APRI等指标联合应用,可有效提高肝纤维化的预测准确性,具有较高的临床实用价值。
Abstract
Objective To investigate the correlation between routine laboratory indicators and the severity of liver fibrosis in patients with chronic hepatitis B virus (HBV) infection. Methods This retrospective study analyzed clinical data from 202 patients with chronic HBV infection who were admitted to the Department of Infectious Diseases at Maoming Clinical Medical College, Affiliated Hospital of Guangdong Medical University, between January 2023 and December 2023. Based on liver stiffness measurement (LSM) values, patients were categorized into fibrosis stages F0-F1(n=84), F2(n=56), F3(n=48), and F4(n=14). Routine blood, coagulation, and liver function indicators were measured and their correlations with liver fibrosis severity were analyzed. Receiver operating characteristic (ROC) curves were used to assess the predictive value of individual and combined indicators in evaluating fibrosis severity, and diagnostic thresholds and area under the curve (AUC) values were determined. Results With the progression of liver fibrosis, levels of platelet count (PLT), prothrombin activity (PTA), albumin (ALB), and cholinesterase (CHE) gradually decreased, reaching their lowest levels at stage F4. In contrast, levels of total bile acid to platelet ratio (TRP), AST-to-platelet ratio index (APRI), total bilirubin (TBIL), direct bilirubin (DBIL), and gamma-glutamyl transferase (GGT) increased with fibrosis stage. Pearson correlation analysis showed that TRP, APRI, TBIL, DBIL, and globulin (GLB) were positively correlated with fibrosis severity, while PLT was negatively correlated. ROC curve analysis revealed that the combination of 13 routine indicators yielded an AUC of 0.930, with a sensitivity of 0.894 and a specificity of 0.923, significantly outperforming any single indicator, indicating high predictive value for the combined assessment. Conclusion Routine laboratory indicators—including blood counts, liver function, and coagulation parameters—are closely associated with the severity of liver fibrosis in patients with chronic HBV infection. Among them, PLT shows the most significant decline in advanced fibrosis. The combined use of indicators such as TRP and APRI can effectively improve the accuracy of fibrosis prediction and holds significant clinical utility.
关键词
慢性乙型肝炎病毒感染 /
血小板数 /
肝纤维化程度 /
相关性
Key words
chronic hepatitis b virus infection /
platelet count /
liver fibrosis severity /
correlation
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基金
茂名市科技计划项目“瞬时弹性成像技术（Fibrotouch®）联合血脂、BMI在预测早期脂肪肝中的价值”（2020031）
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